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Digestive Disorders / Gastroenterology Forum
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Avatar universal

Right Abdominal Pain Since Gallbladder removal (worsening by day)

My wife had her gallbladder removed approx. 10 months ago after family phys. found gallbladder function at 15%.  3 days after the lap. surgery  she was admitted into a local ICU for severe right side upper area pain, which has been there ever since, (no radiant travel of pain accross or down the abdominal area). The pain is located under/behind the first lower rib on her right side about 6-8 inchs from the center breast plate.  On site doctors claimed that this pain was post surgical swelling and it would go away. She was given demeral drip and released after 1 1/2 days.  She regularly complained of sharp pains in that area after performing physical task requiring lifting/stretching of the right side or right arm. 4 months ago the pain reached a level that required a visit to the local E.R. After X-rays and blood work, the ER physician said the pain was due to "slightly" packed bowls.  A pain shot was given for pain and E.R. Dr said to take a natural laxative, she was back in the E.R. the next night for severe dehydration and original pain of right side. Since that time she has had 7 trips to the emergancy room, 8 visits to the family Dr.. There have been 6 X-rays done to the area of pain, an upper scope, a Spirral C/T scan with contrast at 3mm.  An MRI of the upper and lower back area's. Numerous numbers of blood test, all of which showed nothing that the Physicians could even remotely claim to cause this pain.  The only common demoniator is that the last 4 sets of X-rays showed full bowels and these 2 metal clip things attached to the area where the gallbladder was before removal.  I have seen these X-rays many times and one of these clips are sticking up at approx a 20-25 degree angle. (center/0 deg angle being the right inner shoulder).  The other clip (left one, if you are face to face with my wife) is lying down at a left tilt angle of aprox 45-55 deg center/0 deg being the same reference point as stated above.  She has been prescribed (excuse the spelling on these) Loritab, Talwin, Oxycodon, and several other local IV's at the ER to help with the pain.  This pain has really really gotten worse in the last 5 to 7 weeks.  She almost cries herself to sleep everynight now due to the sharp pain in her right side.  Sometimes she said its a sharp stabbing pain that turns into a burning stabbing pain.  Non of which are superficial, all the pain felt can best be described as deep and under the ribs.  Our physician which we changed too approx. 4 weeks ago referred us to another surgeon but warned us that surgeons dont like going back in behind other surgeons to do any additional mending/repairs. After several trips to this new family Dr. and numerous NON-returned phone messages I accidently found this web-site and figured "what the hell". So if any of you medical professionals out there reading this post has some idea's let us know.  My 9 year old daughter and I will be right here by the computer watching mommy float around the room on her new drugs
63 Responses
233190 tn?1278553401
MEDICAL PROFESSIONAL
Difficult to say without examination.

Post-op surgical changes are certainly possible - and should be evaluated by the surgeon who did the procedure.

One can also consider Sphincter of Oddi dysfunction.  This can replicate gallbladder pain in those who have had their gallbladders removed.  An ERCP with a Sphincter of Oddi manometry can be considered to evaluate this possibility.  

Otherwise, a pretty comprehensive set of imaging studies have already been performed - ruling out most of the major causes.

If the cause continues to be non-revealing, a referral to a pain management clinic can be considered to appropriately manage the pain medications.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b
Avatar universal
It definately sounds like something was put back together wrong. For as long as she's been suffering, I would say she would probably welcome the opportunity for them to open her up and take a look. Sometimes all the tests/scans can't see what the eye can when a person is opened up. Laproscopic surgery is great for some people, but for a few there can be serious complications. I say keep calling surgeons, preferably at a different hospital/medical group, until you find one willing to do exploratory surgery. They may have accidentelly blocked off the biliary duct to the small intestine which seems like it could lead to full bowels. (I am only saying this because too much bile in the small bowel leads to diaharrea, so conversely too little should lead to slow bowels.) Don't let them go laproscopic again. A scar would be a small price to pay for sucess. Good luck. You'll be in my prayers.
Avatar universal
Please follow through on the doc's suggestion about checking on SOD. It's unfortunate, but there are many people who seem to either develop the condition following gallbladder surgery, or may have previously had the condition and it was only 'uncovered' after the gallbladder is removed. The pain is described by many as very similar to that experienced when they were having gallbladder problems and in some cases can have a person on the floor curled into a fetal position in agony. If you do consult with docs and find that the condition may be SOD, please seek out someone experienced with the condition to get treatment. And as Dr. Kevin suggested request manometry, keeping in mind that many places do not have the capabilities to do the ERCP with manometry, so you may have to look and ask.

Some docs will do an ERCP and perform a sphincterotomy as as standard measure when a patient has pain. However, if a rise in pressure cannot be confirmed via manometry it might not be the best idea.

If the problem is SOD, certain drugs in the opiate class can increase ductal pressures and might make the pain worse, so please talk to your doc about that possibility while you are trying to get to the cause of the problem.

A decent site to read about SOD is: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=3&disease=12&lang_id=1 I would suggest that you and your wife learn all that you can about postcholecystectomy problems to see if what she is going through might match what you find out. You will better be able to discuss the problems with the doctors you will be talking with. You might also search the Medscape and eMedicine websites for further information.

I hope your wife will be able to get some relief soon.

Avatar universal
Do they know what those metal clip things are?? Hopefully they didn't leave something behind after her surgery.
Avatar universal
Hi I read your threads about certain meds effecting sod, I went to the john hopkins site you posted, while they have alot of info I didn't find anything on opiates effecting sod.  I believe this might be a problem for me and would love to speak with you about this, please email me.

***@****

  I would appreciate this greatly........Denise
Avatar universal
If I were in your shoes I would take your wife to a major medical center such as a teaching hospital at a university. I don't know if your from the US or not but this type of hospital like the one at your state university will probe more & get to the bottom of this pain. There is something definetly wrong, pain of that quality & duration isn't normal. Keep in mind the pain medication that she is using is known for the side effect of constipation. The fact that she is full of stool could also have an effect on the pain level causing pressure on the area. I would not fool around with the Dr's in your area any more, sounds like they are all talk & no action. She needs an exploratory surgery. Take her in on emergency to one of these teaching hospitals. I am from Michigan & the center I have in mind is the U of M Hospital. Or go to Cleveland Clinic or some other speciality hospital.

I'm sorry you have to go through this but don't give up.
God Bless & I'll pray for you and your family, Jean
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